Treatment Of Suicidal Patients Research Articles

Self-Burdensomeness, Self-Esteem and Suicidal Ideation

BackgroundLow self-esteem and self-burdensomeness have been proposed as risk factors for suicidal ideation. Yet, self-burdensomeness may be more relevant to suicidal ideation than low self-esteem. The purpose of the present study was to investigate the association between self-esteem, self-burdensomeness, and suicidal ideation in a sample of adult outpatients.MethodsData from N = 202 patients (66.3% female; age: M[SD] = 39.87 [13.31], range: 19–73) who started therapy at an outpatient clinic were collected. A subsample of n = 111 patients (68.5% female; age: M[SD] = 38.50 [13.48], range: 20–73) also took part in a second assessment three-months later.ResultsSelf-burdensomeness was shown to predict suicidal ideation concurrently and prospectively – after controlling for age, gender, depression, and self-esteem. Furthermore, self-burdensomeness completely mediated the association between self-esteem and suicidal ideation. However, the reverse relationship, where the association between self-burdensomeness and suicidal ideation is mediated by self-esteem, was not supported.ConclusionsSelf-burdensomeness might be understood as a driver of suicidal ideation. Findings point to the possibility that a focus on self-burdensomeness and/or low self-esteem might be relevant in the treatment of suicidal patients.

Impulsivity and aggression in suicide ideators and suicide attempters of high and low lethality

BackgroundImpulsivity and aggression have been associated with all forms of suicidal behaviour and linked to theories of suicide capability. There is a need to clarify the role of impulsivity and aggression in the progression from suicidal thoughts to suicide attempts and suicide.MethodIn this naturalistic cross-sectional study, suicide ideators (35), low lethal suicide attempters (37), and high lethal suicide attempters (26) were compared with the Columbia-suicide severity rating scale (C-SSRS), Barratt impulsiveness scale (BIS-11), and the Buss & Perry aggression questionnaire (AQ).ResultsPhysical aggression score (p = 0.032) contributed to the difference between predicted low lethal suicide attempt and predicted high lethal suicide attempt. This model predicting physical aggression showed a fairly weak positive relationship (OR = 1.1) to high lethal attempt and explained 13% of the variance so there is a need for further replications to verify these results. Impulsive behaviour scores in females were significantly higher in the low lethal suicide attempt group compared to suicide ideators (F(2.51) = 3.47, p = 0.039, η²= 0.12). Hostility aggression in females was significantly higher in the high lethal suicide attempters compared to suicide ideators (F(2.52) = 3.53, p = 0.037, η² = 0.12). Physical aggression scores in females were significantly higher in the high lethal attempters compared to suicide ideators (F(2.52) = 6.79, p = 0.002, η²= 0.21). When these analyses were conducted without the participants who died in suicide, men in the high lethal attempt group scored significantly higher than men in the low lethal attempt group (F(2.37) = 3.8, p = 0.031, η² = 0.17), but men did not differ in aggression and impulsivity scores in other comparisons.ConclusionSuicide prevention should address physical aggression, as high levels can be associated with high lethal attempts. Assessment of suicidal patients should address impulsive behaviour with the insight that it can be more prominent in female low lethal suicide attempters. It could be that assessment and treatment of suicidal patients should be tailored differently for men and women. Aggression as a feature of suicide capability could be the link that makes suicide possible.

Age Progression in the Treatment of Suicidal Patients

ABSTRACT Suicide is a very distressing but preventable phenomenon; it is also the most profound and serious outcome for patients and healthcare professionals. Suicidal ideations and hopelessness are a high-risk predictor for suicide attempts and death by suicide. The proper therapeutic management of suicidal patients continues to be an important challenge to all practicing clinicians. This article provides a review of age progression and specific information on the value and use of hypnotically mediated age progression as a therapeutic tool in the effective clinical management of patients with suicidal thoughts and behaviors. Case examples are provided to illustrate the use of age progression in clinical practice. The literature that explores a future-oriented strategy in the treatment of suicidal patients is reviewed. Moreover, information on a method of enhancing a future oriented strategy with hypnotically mediated age progression interventions is provided. The goal is to improve therapeutic results and reducing the risk of suicide attempts and death by suicide.

Exposure to Early Life Adversity and Interpersonal Functioning in Attempted Suicide.

BackgroundEarly life adversity (ELA) may lead to an increased risk for mental health problems including suicidal behavior. ELA alters biological stress systems that affect behavior and control within the individual that in turn will affect interpersonal behavior. Strained relations and interpersonal conflicts leading to rejection and isolation have been shown to be factors for suicidal behavior. Difficulties in interpersonal relationships are a common reason for seeking help in psychiatric care. In the present study, we examined relationship between different types of interpersonal problems and adverse childhood experiences in patients with a recent suicide attempt.MethodThe study included 181 recent suicide attempters. We assessed early life adversity and specific interpersonal problems by using the Karolinska Interpersonal Violence Scale and the Inventory of Interpersonal problems respectively.ResultsSuicide attempters with high levels of early life adversity expressed a more socially avoidant, non-assertive, and exploitable personal style even after adjustment for comorbidities with personality disorder and substance use disorder.ConclusionsPatients with a recent suicide attempt with high levels of early life adversity tend to isolate themselves, of being introvert, and having difficulties to open up and confide in others. They report low self-confidence and self-esteem and problems with feeling and expressing anger. These behaviors complicate interaction with others and make establishment of solid relationships more difficult. In regards to detection of suicidal communication and treatment of suicidal patients, this may lead to misinterpretations and difficulties to fully benefit from treatment given or for professionals to provide the appropriate treatment. Clinicians should closely investigate the presence of early life adversity in suicidal patients and pay attention to their personal style and their difficulties in interpersonal exchange.

Retrospective analysis of reported suicide deaths and attempts on veterans health administration campuses and inpatient units

IntroductionSuicide is the 10th leading cause of death in the USA. Inpatient suicide is the fourth most common sentinel event reported to the Joint Commission. This study reviewed root cause...

The treatment in the Danish suicide prevention clinics: a clinician perspective

Background: Few qualitative studies have focused on clinicians’ perspectives regarding treatment of suicidal people. Despite limited evidence and imperfect risk-assessment tools, the psychosocial therapy at the Danish suicide prevention clinics has been linked to reductions in numbers of repeated self-harm, deaths by suicide, and other causes. This merits an investigation into how clinicians describe their practice. Methods: Using a qualitative design, 10 semi-structured interviews were conducted and analyzed to describe the psychosocial therapy. Results: The practices that the therapists described could be categorized along four dichotomous continuums. These illustrated dilemmas encountered during treatment of suicidal patients: 1) intuitive vs. specific risk assessment, 2) meaningful vs. formal, 3) patient-oriented vs. therapist-oriented and 4) direct vs. indirect approach to suicide prevention. Conclusions: Treatment in the Danish Suicide Prevention Clinics is characterized by methodological flexibility and diversity and with an emphasis on a patient-oriented approach. Furthermore, clinicians balance knowledge available by switching between a direct and an indirect approach according to the perceived suicide risk. If suicide risk was perceived as high, they would administer a direct approach and if low, an indirect approach. Finally, there seems to be differences as to how effective therapeutic methodologies work in the practice of suicide prevention.

Smartphone-based safety planning and self-monitoring for suicidal patients: Rationale and study protocol of the CASPAR (Continuous Assessment for Suicide Prevention And Research) study

BackgroundIt remains difficult to predict and prevent suicidal behaviour, despite growing understanding of the aetiology of suicidality. Clinical guidelines recommend that health care professionals develop a safety plan in collaboration with their high-risk patients, to lower the imminent risk of suicidal behaviour. Mobile health applications provide new opportunities for safety planning, and enable daily self-monitoring of suicide-related symptoms that may enhance safety planning. This paper presents the rationale and protocol of the Continuous Assessment for Suicide Prevention And Research (CASPAR) study. The aim of the study is two-fold: to evaluate the feasibility of mobile safety planning and daily mobile self-monitoring in routine care treatment for suicidal patients, and to conduct fundamental research on suicidal processes. MethodsThe study is an adaptive single cohort design among 80 adult outpatients or day-care patients, with the main diagnosis of major depressive disorder or dysthymia, who have an increased risk for suicidal behaviours. There are three measurement points, at baseline, at 1 and 3 months after baseline. Patients are instructed to use their mobile safety plan when necessary and monitor their suicidal symptoms daily. Both these apps will be used in treatment with their clinician. ConclusionThe results from this study will provide insight into the feasibility of mobile safety planning and self-monitoring in treatment of suicidal patients. Furthermore, knowledge of the suicidal process will be enhanced, especially regarding the transition from suicidal ideation to behaviour.The study protocol is currently under revision for medical ethics approval by the medical ethics board of the Vrije Universiteit Medical centre Amsterdam (METc number 2017.512/NL62795.029.17).

Emotional Responses to Suicidal Patients: Factor Structure, Construct, and Predictive Validity of the Therapist Response Questionnaire-Suicide Form.

Mental health professionals have a pivotal role in suicide prevention. However, they also often have intense emotional responses, or countertransference, during encounters with suicidal patients. Previous studies of the Therapist Response Questionnaire-Suicide Form (TRQ-SF), a brief novel measure aimed at probing a distinct set of suicide-related emotional responses to patients found it to be predictive of near-term suicidal behavior among high suicide-risk inpatients. The purpose of this study was to validate the TRQ-SF in a general outpatient clinic setting. Adult psychiatric outpatients (N = 346) and their treating mental health professionals (N = 48) completed self-report assessments following their first clinic meeting. Clinician measures included the TRQ-SF, general emotional states and traits, therapeutic alliance, and assessment of patient suicide risk. Patient suicidal outcomes and symptom severity were assessed at intake and one-month follow-up. Following confirmatory factor analysis of the TRQ-SF, factor scores were examined for relationships with clinician and patient measures and suicidal outcomes. Factor analysis of the TRQ-SF confirmed three dimensions: (1) affiliation, (2) distress, and (3) hope. The three factors also loaded onto a single general factor of negative emotional response toward the patient that demonstrated good internal reliability. The TRQ-SF scores were associated with measures of clinician state anger and anxiety and therapeutic alliance, independently of clinician personality traits after controlling for the state- and patient-specific measures. The total score and three subscales were associated in both concurrent and predictive ways with patient suicidal outcomes, depression severity, and clinicians' judgment of patient suicide risk, but not with global symptom severity, thus indicating specifically suicide-related responses. The TRQ-SF is a brief and reliable measure with a 3-factor structure. It demonstrates construct validity for assessing distinct suicide-related countertransference to psychiatric outpatients. Mental health professionals' emotional responses to their patients are concurrently indicative and prospectively predictive of suicidal thoughts and behaviors. Thus, the TRQ-SF is a useful tool for the study of countertransference in the treatment of suicidal patients and may help clinicians make diagnostic and therapeutic use of their own responses to improve assessment and intervention for individual suicidal patients.

Countertransference Reactions to a Suicidal Patient

Countertransference Reactions to a Suicidal Patient

Patient safety priorities in mental healthcare in Switzerland: a modified Delphi study

ObjectiveIdentifying patient safety priorities in mental healthcare is an emerging issue. A variety of aspects of patient safety in medical care apply for patient safety in mental care as well....

Treating suicidal risk in a post-healthcare reform era

Purpose– The purpose of this paper is to fully consider the potential changes in clinical suicide prevention that may evolve after the passing of the Patient Protection and Affordable Care Act (ACA). The authors argue that it is wise to anticipate demand for suicide-specific evidence-based treatments (EBTs) moving forward. The authors outline current best practices in clinical suicide prevention, and describe the Collaborative Assessment and Management of Suicidality (CAMS) as an example of how a suicide-focussed EBT can adapt to some predicted changes.Design/methodology/approach– This conceptual paper first presents an overview of the main effects of ACA within the behavioral health care (BHC) system. Next, the authors review contemporary approaches to the treatment of suicidal patients, as well as current treatment limitations. The authors present CAMS as a model of a suicide-focussed EBT that holds promise for use in the post-ACA era. To close, the authors discuss anticipated changes in suicide treatment and illustrate that CAMS is adaptable to these changes.Findings– ACA mandates several changes: implementation of EBTs, better preventative care, integrated treatment models, and improved healthcare administration. A central effect of ACA in BHC is the increased use of EBTs. Therefore effective EBTs for suicide prevention are described.Originality/value– Anticipating how ACA will affect clinical suicide prevention is necessary, as it is historically a very challenging area of treatment within BHC and a significant public health concern. This paper highlights the importance of the use suicide-specific EBTs.

Cognitive Behavioral Therapy and Dialectical Behavioral Therapy in Suicidal Patients

Introduction Suicidality is a serious social problem. There is a limited evidence of pharmacotherapeutic options, therefore cognitive-behavioral therapy (CBT) and dialectical-behavioral therapy (DBT) play the crucial role in treatment of suicidal patients. Method The search covered databases Web of Science and Pub Med. Search was limited by the years 1990 to 2013. Results Main psychotherapeutic strategies in acute phase are based on intervention; making contact, identification of the stressors and developing of therapeutic relationship. The most important aspects of CBT approach concern teaching the patient how to understand stimulus of suicidal behaviour, how to control emotions and search for the reasons to live. DBT has proven its effectiveness in coping with emotional lability, which can lead to suicidal behaviour. The basic DBT principles include stress tolerance, emotional regulation and interpersonal effectiveness. Conclusion Despite the frequent use of CBT in the treatment of suicidal patients, the evidence of effectiveness from the studies of this approach is not sufficient enough. Problem solving strategies have been confirmed as effective. DBT proved to be successful in the treatment of suicidality of borderline personality disorder.

Presence and persistence of sleep-related symptoms and suicidal ideation in psychiatric inpatients.

Although sleep is an important risk factor for suicidal behavior, research has yet to examine the association between sleep problems and suicidality across the course of inpatient treatment. This study examined the relationship among sleep-related symptoms and suicidal ideation across inpatient treatment. To examine whether poor sleep at admission longitudinally predicts less improvement in suicidal ideation over the course of treatment. Further, to examine whether suicidal ideation is reduced in patients whose sleep does not improve. The study utilized the Beck Depression Inventory (BDI)-II, which contains items measuring depressive symptoms, sleep-related symptoms, and suicidal ideation. The study sample consisted of 1,529 adult psychiatric inpatients. Patients were assessed at admission, biweekly, and at treatment termination. Admission fatigue, loss of energy, and change in sleep pattern were associated with higher levels of suicidal ideation at admission and discharge. Fatigue at admission predicted suicidal ideation at termination independent of admission depression and suicidal ideation. Individuals whose sleep did not improve over the course of treatment had significantly higher suicidal ideation scores at termination relative to those whose sleep symptoms improved, after controlling for sleep, depression, and suicidal ideation scores at admission. These findings suggest that persistence of sleep-related symptoms warrants clinical attention in the treatment of suicidal patients.

Anhedonia predicts suicidal ideation in a large psychiatric inpatient sample

This study examined the relationship among symptoms of anhedonia and suicidal ideation at baseline, at termination, and over time in 1529 adult psychiatric inpatients. Anhedonia was associated with suicidality cross-sectionally at baseline and at termination. In addition, change in anhedonia from baseline to termination predicted change in suicidality from baseline to termination, as well as level of suicidality at termination; moreover, anhedonia remained a robust predictor of suicidal ideation independent of cognitive/affective symptoms of depression. Symptom-level analyses also revealed that, even after accounting for the physical aspect of anhedonia (e.g., loss of energy), loss of interest and loss of pleasure were independently associated with higher levels of suicidal ideation at baseline, over time, and at discharge. Loss of interest was most highly predictive of suicidal ideation, providing support for recent differential conceptualizations of anhedonia. Taken together, these findings indicate that the manner in which anhedonia is conceptualized is important in predicting suicidal ideation, and that anhedonia symptoms warrant particular clinical attention in the treatment of suicidal patients.

Suicide risk assessment in clinical practice: Pragmatic guidelines for imperfect assessments.

This practice review focuses on the challenges of conducting sensitive and accurate assessments of the relative risk for suicide attempts and completed suicides. Suicide and suicide attempts are a frequently encountered clinical crisis, and the assessment, management, and treatment of suicidal patients is one of the most stressful tasks for clinicians. An array of risk factors, warning signs, and protective factors associated with suicide risk are reviewed; however, we are not yet in possession of evidence-based diagnostic tests that can accurately predict suicide risk on an individual level without also creating an inordinate number of false-positive predictions. Given the current limitations of assessment strategies, clinicians are advised to keep in mind that patients contemplating suicide are under enormous psychological distress, requiring sensitive and thoughtful engagement during the assessment process. An overarching goal of these assessments should be conducted within the therapeutic frame, in which efforts are made to enhance the therapeutic alliance by negotiating a collaborative approach to assessing risk and understanding why thoughts of suicide are so compelling. Within this treatment heuristic, the Suicide Assessment Five-step Evaluation and Triage (SAFE-T) is recommended as a pragmatic multidimensional assessment protocol incorporating the best known risk and protective factors.

La filière de soin des suicidants aux urgences

In France, a suicide attempt is recorded every 40 seconds, and a death by suicide occurs every 40 minutes. Suicide is the primary cause of mortality in people aged between 15 and 45 years. Suicidal tendencies have been identified as a major public health issue since the 1990s. Mental illnesses (including depression, schizophrenia, and addictions) as well as any personal and family history of suicidal behaviour are major risk factors. Identification and treatment of people in a suicide crisis and/or making a suicide attempt can help prevent repeated suicide attempts. Recommendations for good practice make a hospital, and in particular the emergency departments, a requisite location where a multidisciplinary approach is available. This leads to the need to organize a care process from reception to guidance based on an evaluation in three steps: physical, psychological, and social. The implementation of hospital care and/or intensive outpatient follow-up needs to be adjusted to match each situation. Training general practitioners in detection and treatment of suicidal patients and/or those suffering from depression is critical. Training is also necessary for teams in the emergency departments and in the crisis services with specialisation in handling suicidal adolescents or elderly people in some of them. The emergency wards are also, in a large number of cases, the first place of contact with a psychiatric. The quality of welcoming initial cares, relationships between the nursing staff and carers within the hospital and between the downstream organisations will determine to what extent the patients being treated will continue their treatment, will ensure the continuity of care, and will help to prevent repeated attempts.

A Guide for the Assessment and Treatment of Suicidal Patients With Traumatic Brain Injuries

People with traumatic brain injuries (TBIs) are at elevated risk for suicide. Postinjury cognitive limitations, personality factors, and psychological problems may independently or in conjunction with preinjury correlates contribute to suicidal thoughts and behaviors. Rehabilitation practitioners can best serve the needs of this high-risk population by increasing their knowledge and competence in evidence-informed approaches to suicide prevention. This article provides a review of suicide nomenclature, epidemiology, risk and protective factors, as well as evidence-informed assessment, management, and treatment practices for suicidal patients. The science of clinical practice in the area of rehabilitation and suicide prevention is in its infancy. Practitioners who provide treatment for suicidal patients with TBI are encouraged to adapt and individualize existing evidence-informed suicide assessment and prevention practices for implementation within their settings. Each patient with a TBI who endorses suicidal thoughts and/or behaviors presents a complex array of clinical challenges associated with the nature of his or her brain injury, preinjury, and postinjury functioning. Clinical as well as research recommendations are provided in the context of an understanding of such challenges and an overriding objective of minimizing suicide risk during the recovery process and maximizing treatment gains.

ECP05-03 - Treatment of suicidal patients: Legal and ethical aspects

According to WHO estimates, 1.5 million people worldwide will complete suicide in the year 2020 and approximately 10-20 times this number will attempt suicide. Given that suicide still remains the most serious outcome of mental disease, it is essential that psychiatrists are specifically trained regarding legal and ethical aspects related to the treatment of suicidal psychiatric patients.Clinical decisions guided by evidence based knowledge and ethical judgments according to the principles of beneficence, non-maleficence and autonomy intimately interact when a psychiatrist performs suicide risk assessment, recommends treatment and follow- up rehabilitation measures. Ethical dilemmas of respecting acute suicidal or chronic suicidal patient's autonomy when she/he is unable to control self-destructive impulses, confidentiality, Do Not Resuscitate (DNR) orders and involuntary confinement for the institutional ward will be discussed.Existing research indicates that suicide risk is higher in the immediate aftermath of discharge from the hospital and when patients are transferred to outpatient care without securing the follow- up visit. Psychiatrists are sometimes under considerable pressure, due to economical downsizing of the psychiatric care, to discharge suicidal patients from inpatient care, which can lead to serious legal and ethical repercussions. Following evidence-based procedures is crucial, as well as maintaining a high standard of documentation for all processes and decisions taken.Continuous education of health care staff, scrutiny of existing routines and knowledge about own attitudes towards suicidal patients are needed in order to prevent suicide.

Suicidal imagery in a previously depressed community sample

This study sought to replicate previous findings of vivid suicide-related imagery in previously suicidal patients in a community sample of adults with a history of depression. Twenty-seven participants were interviewed regarding suicidal imagery. Seventeen participants reported prior suicidal ideation or behaviour in the clinical assessment, and the vast majority of these also reported experiencing suicide-related imagery when at their most depressed and despairing, in many cases in the form of flash-forwards to imagined future suicidal acts. Interestingly, five of the 10 participants who did not report suicidal ideation or behaviour in the clinical interview also described prominent imagery related to themes of death and suicide, but in several cases, these images were associated with meanings that seemed to act to reduce the likelihood of subsequent suicidal acts. Severity of prior suicidality was associated with lower levels of imagery-related distress and higher levels of imagery-related comfort. These findings support the idea that suicide-related imagery is an important component in the phenomenology of depression and despair and hint at potentially important differences in the meaning associated with such imagery between those individuals who report experiencing suicidal ideation or behaviour when depressed and those who do not. The findings are consistent with Joiner's model of acquired capability for suicide through habituation to pain and fear of suicide and suggest that it may be useful to tackle such imagery directly in the treatment of suicidal patients.

Nurses' Psychosocial Barriers to Suicide Risk Management

Suicide remains a serious health care problem and a sentinel event tracked by The Joint Commission. Nurses are pivotal in evaluating risk and preventing suicide. Analysis of nurses' barriers to risk management may lead to interventions to improve management of suicidal patients. These data emerged from a random survey of 454 oncology nurses' attitudes, knowledge of suicide, and justifications for euthanasia. Instruments included a vignette of a suicidal patient and a suicide attitude questionnaire. Results. Psychological factors (emotions, unresolved grief, communication, and negative judgments about suicide) complicate the nurse's assessment and treatment of suicidal patients. Some nurses (n = 122) indicated that euthanasia was never justified and 11 were unsure of justifications and evaluated each case on its merits. Justifications for euthanasia included poor symptom control, poor quality of life, incurable illness or permanent disability, terminal illness, and terminal illness with inadequate symptom control or impending death, patient autonomy, and clinical organ death. The nurses indicated some confusion and misconceptions about definitions and examples of euthanasia, assisted suicide, and double effect. Strategies for interdisciplinary clinical intervention are suggested to identify and resolve these psychosocial barriers.